A set of behaviour patterns characterized by excessive hostility, competitiveness, and impatience have been identified in patients with coronary heart disease (CHD) and labelled "Type A". Since several studies have shown that the Type A behaviour pattern is an independent psychological risk factor for heart disease, attempts have been made to modify the behaviour pattern in both healthy subjects and patients suffering from CHD by altering physiological, cognitive and behavioural characteristics. The present research offers an alternative approach to the modification of physiological responses in healthy Type A adults and adolescents. It is proposed that the core elements of Type A such as competition could be exploited in order to induce physiological relaxation rather than excitement. Four experiments were carried out. The first study identified behavioural and physiological characteristics of Type A subjects such as increased heart rate while competing. The second experiment used contingent and false heart rate biofeedback training to challenge Type A adults to decrease heart rate in a competitive situation. Biofeedback was found to be an effective method of training Type A subjects to relax. Furthermore, it was found that Type As decreased heart rate significantly more than other subjects when challenged to do so by biofeedback. As a first step in attempting a similar approach with adolescents and to see if an identifiable pattern of beliefs and fears associated with Type A exists in the younger population, a questionnaire was designed to identify these beliefs and fears. Type A adolescents were found to hold a similar pattern of beliefs and fears to that shown in adult subjects in previous studies. Furthermore, measures of beliefs and fears correlated significantly but modestly with measures of Type A. Using heart rate biofeedback, competition did not seem to have any specific effect on the performance of Type A adolescents. Nevertheless, Type As were found to be more responsive to biofeedback training than Type Bs and results for subjective reports of relaxation were encouraging. The results are discussed in terms of using challenging incentives to reduce physiological responses in Type A adults and adolescents. It is argued that programmes aimed at modifying Type A in healthy individuals have produced mixed results and have repeatedly failed to alter physiological responses. This is due to many problems including the fact that the negative consequences of the behaviour pattern are not readily recognized and therefore healthy Type As may be resistant to change. Furthermore, there are ethical issues involved in actually altering behaviour in an apparently healthy population. It is proposed that in view of these problems, challenging incentives such as competition could play a significant role in the reduction of physiological responses in healthy Type A individuals particularly the younger population
